Thursday, February 23, 2012
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Parish Registration Form
Page 1 of 4
Family Name
Salutation (Mr & Mrs, Dr. etc.) (*)
Please enter a Salutation.
First Name (*)
Please type your first name.
Last Name (*)
Please type your last name.
Home Address
Address (*)
Please enter your street address.
City (*)
Please enter your home city.
State (*)
Please enter your home state.
Zip Code (*)
Please enter your home Zip Code.
Mailing Address (if different)
Address
Please enter your mailing street address.
City
Invalid Input
State
Invalid Input
Residency Status (*)
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Seasonal Residency From to
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Home Phone (*)
Please enter your home phone.
Listed?
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E-mail (*)
Invalid email address.
   
Page 2 of 4
Married by Catholic Church? (*)
Invalid Input
Marriage Date (MM/DD/YY) (*) //
Please enter the month of your date of marriage.Please enter the day your were married.Please enter the year you were married.
  
Marriage Remarks
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How long have you attended Holy Name of Jesus?
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Which Mass(es) do you normally attend?





Invalid Input
How can HNJ help you?
Invalid Input
Do you have any special needs?
Invalid Input
   
Page 3 of 4
Family Members
Head of Household
First Name (*)
Invalid Input
Middle Initial
Invalid Input
Sex (*)
Invalid Input
Birthday (MM/DD/YY) (*) //
Please enter the month of your date of birth.Please enter the day of your birthday.Please enter the year you were born.		  
Sacraments Received




Invalid Input
Marital Status
Invalid Input
Religion
Invalid Input
Religion if not Catholic
Invalid Input
Physical Challenge
Invalid Input
Languages
Invalid Input
Church Attendance
Invalid Input
Occupation / Other e.g. Student, Retired etc
Invalid Input
Employer / School Name
Invalid Input
Highest Degree or Current Grade
Invalid Input
Member Remarks
Invalid Input
Number of Family Members
Invalid Input
Family Member #1
Relationship to Head of Household
Invalid Input
If other, please specify
Invalid Input
First Name
Invalid Input
Middle Initial
Invalid Input
Sex
Invalid Input
Birthday (MM/DD/YY) //
Please enter the month of your date of birth.Please enter the day of your birthday.Please enter the year you were born.
Sacraments Received




Invalid Input
Marital Status
Invalid Input
Religion
Invalid Input
Religion if not Catholic
Invalid Input
Physical Challenge
Invalid Input
Languages
Invalid Input
Church Attendance
Invalid Input
Occupation / Other e.g. Student, Retired etc
Invalid Input
Employer / School Name
Invalid Input
Highest Degree or Current Grade
Invalid Input
Member Remarks
Invalid Input
Family Member #2
Relationship to Head of Household
Invalid Input
If other, please specify
Invalid Input
First Name
Invalid Input
Middle Initial
Invalid Input
Sex
Invalid Input
Birthday (MM/DD/YY) //
Please enter the month of your date of birth.Please enter the day of your birthday.Please enter the year you were born.
Sacraments Received




Invalid Input
Marital Status
Invalid Input
Religion
Invalid Input
Religion if not Catholic
Invalid Input
Physical Challenge
Invalid Input
Languages
Invalid Input
Church Attendance
Invalid Input
Occupation / Other e.g. Student, Retired etc
Invalid Input
Employer / School Name
Invalid Input
Highest Degree or Current Grade
Invalid Input
Member Remarks
Invalid Input
Family Member #3
Relationship to Head of Household
Invalid Input
If other, please specify
Invalid Input
First Name
Invalid Input
Middle Initial
Invalid Input
Sex
Invalid Input
Birthday (MM/DD/YY) //
Please enter the month of your date of birth.Please enter the day of your birthday.Please enter the year you were born.
Sacraments Received




Invalid Input
Marital Status
Invalid Input
Religion
Invalid Input
Religion if not Catholic
Invalid Input
Physical Challenge
Invalid Input
Languages
Invalid Input
Church Attendance
Invalid Input
Occupation / Other e.g. Student, Retired etc
Invalid Input
Employer / School Name
Invalid Input
Highest Degree or Current Grade
Invalid Input
Member Remarks
Invalid Input
Family Member #4
Relationship to Head of Household
Invalid Input
If other, please specify
Invalid Input
First Name
Invalid Input
Middle Initial
Invalid Input
Sex
Invalid Input
Birthday (MM/DD/YY) //
Please enter the month of your date of birth.Please enter the day of your birthday.Please enter the year you were born.
Sacraments Received




Invalid Input
Marital Status
Invalid Input
Religion
Invalid Input
Religion if not Catholic
Invalid Input
Physical Challenge
Invalid Input
Languages
Invalid Input
Church Attendance
Invalid Input
Occupation / Other e.g. Student, Retired etc
Invalid Input
Employer / School Name
Invalid Input
Highest Degree or Current Grade
Invalid Input
Member Remarks
Invalid Input
Family Member #5
Relationship to Head of Household
Invalid Input
If other, please specify
Invalid Input
First Name
Invalid Input
Middle Initial
Invalid Input
Sex
Invalid Input
Birthday (MM/DD/YY) //
Please enter the month of your date of birth.Please enter the day of your birthday.Please enter the year you were born.
Sacraments Received




Invalid Input
Marital Status
Invalid Input
Religion
Invalid Input
Religion if not Catholic
Invalid Input
Physical Challenge
Invalid Input
Languages
Invalid Input
Church Attendance
Invalid Input
Occupation / Other e.g. Student, Retired etc
Invalid Input
Employer / School Name
Invalid Input
Highest Degree or Current Grade
Invalid Input
Member Remarks
Invalid Input
Family Member #6
Relationship to Head of Household
Invalid Input
If other, please specify
Invalid Input
First Name
Invalid Input
Middle Initial
Invalid Input
Sex
Invalid Input
Birthday (MM/DD/YY) //
Please enter the month of your date of birth.Please enter the day of your birthday.Please enter the year you were born.
Sacraments Received




Invalid Input
Marital Status
Invalid Input
Religion
Invalid Input
Religion if not Catholic
Invalid Input
Physical Challenge
Invalid Input
Languages
Invalid Input
Church Attendance
Invalid Input
Occupation / Other e.g. Student, Retired etc
Invalid Input
Employer / School Name
Invalid Input
Highest Degree or Current Grade
Invalid Input
Member Remarks
Invalid Input
   
Page 4 of 4
Make a deliberate decision to commit your time and talents to service God and His people. Before each selection, please indicate the name of the volunteer(s).
Worship
Liturgical Ministries
Altar Care/Sacristy
Invalid Input
Altar Servers
Invalid Input
Church Environment
Invalid Input
Ecumenism
Invalid Input
Eucharistic Ministry
Invalid Input
General & Intercessory Prayers
Invalid Input
Greeters
Invalid Input
Lectors
Invalid Input
Music Ministry
Invalid Input
Ushers
Invalid Input
Video Ministry
Invalid Input
  Pastoral Care  
Bereavement Ministry
Invalid Input
Ministry to the Sick
Invalid Input
Spiritual Companions
Invalid Input
  Prayer  
Charismatic Prayer
Invalid Input
Contemplative Prayer
Invalid Input
Perpetual Adoration
Invalid Input
Ecumenism
Invalid Input
Formation
Children's Liturgy
Invalid Input
HNJ School Volunteers
Invalid Input
Parish Library
Invalid Input
Parish Missions
Invalid Input
Pastoral Ministry
Invalid Input
Religious Education - Adult
Invalid Input
REligious Education - Elementary
Invalid Input
Religious Education - Jr. High / H.S.
Invalid Input
Sacramental Preparation
Invalid Input
Youth Ministry, Gr. 7-8
Invalid Input
Youth Ministry, Gr. 9-12
Invalid Input
Service & Outreach
AIDS Ministry
Invalid Input
Alzheimer's Caregivers Support Group
Invalid Input
Baby Corner
Invalid Input
Child Care
Invalid Input
Congregation for Community Action
Invalid Input
Counseling Center
Invalid Input
Daily Bread
Invalid Input
Daisy Pickers
Invalid Input
Habitat for Humanity
Invalid Input
Medical Equipment Closet
Invalid Input
Respect Life
Invalid Input
Respite Care Ministry
Invalid Input
Rosary Makers
Invalid Input
St. Vincent de Paul Society
Invalid Input
Thrift Shop
Invalid Input
Transportation to Mass
Invalid Input
Evangelization
Baptism Preparation
Invalid Input
Book & Gift Shop
Invalid Input
Catholics Coming Home
Invalid Input
Christ Renews His Parish
Invalid Input
Evangelization Awareness
Invalid Input
HNJ Men's Group
Invalid Input
Kairos Torch & Prison Ministry
Invalid Input
Missionary Outreach
Invalid Input
Sister Parish
Invalid Input
Newcomer's Welcome/Visits
Invalid Input
RCIA (all groups)
Invalid Input
Women of Faith
Invalid Input
Parish & Family
Child Care
-Sunday Nursery -Mom's Day Out -Other Child Care
Invalid Input
Family Support -Contemporary Fathers -Family Social Activities -MOMS -Natural Family Planning -Parenting -Single Adults (SALT)
Invalid Input
Marriages Support -Blended Families - Marriage Encounter -Marriage Enrichment -Marriage Preparation -Retrouvaille
Invalid Input
Divorce Support Ministry -Annulments -Divorce Care -Just Me & the Kids -Rebuilding
Invalid Input
Crown Financial Ministry
Invalid Input
Scouting
Invalid Input
Senior Activities
Invalid Input
Shepherd Center
Invalid Input
Sunday Hospitality
Invalid Input
Widowed, Separated, Divorced
Invalid Input
Women's Guild
Invalid Input
Small Church Community
Small Church Community
Invalid Input
Administration
Bingo Worker (Fri. Night)
Invalid Input
Clerical Worker
Invalid Input
Communications (Newsletter, etc)
Invalid Input
Endowment Development
Invalid Input
Festival Worker
Invalid Input
Mailing Team
Invalid Input
Maintenance (Carpentry, etc)
Invalid Input
Receptionist
Invalid Input
Stewardship Committee
Invalid Input
Special Talents
Artist
Invalid Input
Babysitting—Parish Activities
Invalid Input
Calligraphy
Invalid Input
Carpenter/Electrical/Plumber
Invalid Input
Computer Operator
Invalid Input
Landscaping
Invalid Input
Musician
Invalid Input
Maintenance Repair
Invalid Input
Secretary/Recorder (meetings, etc)
Invalid Input
Telephoning
Invalid Input
Typist
Invalid Input
Pastoral Council
Pastoral Council
Invalid Input
Security Check
Invalid Input